ABSTRACT
The ongoing COVID-19 pandemic drastically changed our lives in multiple aspects, one of which is the reliance on social media during quarantine, both for social interaction and information-seeking purposes. However, the wide dissemination of misinformation on social media has impacted public health negatively. Previous studies on COVID-19 misinformation mainly focused on exploration of impacts and explanation of motivations, with few exceptions. In this study, we propose an analytical pipeline that generates corrective messages toward COVID-19 misinformation in a semiautomatic fashion, and then evaluate it against a large amount of data. Both the automated and manual evaluation results suggest the efficiency of the proposed pipeline, which can be used in combination with human intelligence by individuals and public health organizations in fighting COVID-19 misinformation. © 2022 IEEE Computer Society. All rights reserved.
ABSTRACT
Since the 1960s, many electronic travel aids have been developed for people with low vision or blindness to improve their independent travel skills, but uptake of these specialist devices has been limited. This study investigated what technologies orientation and mobility (O&M) clients in Australia and Malaysia have, use, like, and want to support their travel, to inform technology research and development. This two-phase mixed-methods study surveyed O&M clients face-to-face in Malaysia (n = 9), and online in Australia (n = 50). Participants managed safe walking using a human guide, long cane, or guide dog when their vision was insufficient to see hazards, but a smartphone is now a standard travel aid in both Australia and Malaysia. Participants relied on smartphone accessibility features and identified 108 apps they used for travel: for planning (e.g., public transport timetables), sourcing information in transit (e.g., GPS location and directions, finding a taxi), sensory conversion (e.g., camera-to-voice, voice-to-text, video-to-live description), social connections (e.g., phone, email, Facebook), food (e.g., finding eateries, ordering online), and entertainment (e.g., music, games). They wanted to ‘carry less junk', and sought better accessibility features, consistency across platforms, and fast, reliable, real-time information that supports confident, non-visual travel, especially into unfamiliar places. © The Author(s) 2021.
ABSTRACT
Background: Coincident with capacity strains on our institution's intensive care units (ICUs) during the Covid-19 pandemic, we perceived an increase in the use of oral Midridone (MID) administration for blood pressure (BP) support in septic shock patients to avoid intravenous (IV)-vasoactive medications and ICU admission. Little is known about the efficacy of MID in this patient cohort. The goal of this study was to evaluate the clinical outcomes associated with use of MID to augment blood pressure support in ED patients with septic shock. Method(s): For this single center retrospective review of patients requiring pressor support after sepsis bundle activation, we assessed frequency of IV versus PO vasoactive medication administration both within the ED and after admission on patient outcomes including length of ED stay, admission level of care, discharge disposition, and mortality. Result(s): Of 6293 ED sepsis bundle activations from January 1st, 2019 to April 20th, 2022, 327 (5.2%) of these patients were in shock requiring vasopressors in the ED. Of these patients, 249 received IV vasopressors (IVP), most frequently norepinephrine, but 62 received only MID while 16 patients were given both IVP and MID. The cumulative in-hospital mortality rate (MR) for administration of any of these medications in the ED was 40%. For those who received IVP only, MR was 47%;for MID only it was 14.5%;and for those who received both MR was 31.3%. EDLOS was shortest (6.92 hours) for patients receiving IVP only but increased to 11.7 hours for IVP + MID and 18.9 hours for MID. ICU admission rates were greatest (67.5%) for IVP only patients which decreased to 41.2% for MID + IVP and only 1.6% for MID. Hospital LOS was 7.81 days for IVP only, 12.75 days for MID + IVP, and 6.78 days for MID. Additionally, there were 430 patients who were initially stable in the ED but subsequently decompensated requiring initiation of vasopressive medications after hospital admission with a 40% overall MR for these patients. 210 patients were given IVP (32% MR), 118 requiring only MID (24% MR), while 102 received both (37% MR). Conclusion(s): In this cohort of sepsis patients requiring blood pressure support, patients who received oral Midodrine in place of IVP had longer ED LOS, lower ICU admission rates, and lower mortality rate then patients who received IVP. However, with a less acute ESI score (average 2.1 for MID only vs 1.7 for IVP only) this cohort who composed 19% of septic shock patients presenting to the ED seemed to be considered "less sick" upon arrival. Future prospective research is required to explore the safety and efficacy of oral midodrine in the ED sepsis population requiring blood pressure support. No, authors do not have interests to disclose Copyright © 2022
ABSTRACT
The Covid-19 pandemic was, and continues to be, managed by prevention measures based on limited contact in public spaces and general restrictions on freedom of movement. The question arose as to how infection prevention strategies can be adapted to contexts such as that of the judicial system, particularly prisons. To investigate this, the Swiss National Science Foundation funded a project to analyse institutional strategies to implement prevention measures concerning the Covid-19 pandemic. Surveys were conducted in closed and open institutions of the judicial system across Switzerland, as well as in external residential and work settings, to document successful strategies and identify certain problems. © 2020 Kriminologie. All rights reserved.
ABSTRACT
The COVID-19 pandemic was, and is, managed by prevention measures, based on limited contact in public spaces and general restrictions on freedom of movement. Especially social distancing needs space. So the question was investigated: How social distancing was implemented within the prison system? Reducing overcrowding and suspending prison sentences, are regarded as key elements in combating the pandemic in the justice system. Which further prevention measures could be concretely implemented in Swiss prisons to contain the pandemic? Which conditions as a framework were necessary for reaching this? To investigate this, the Swiss National Science Foundation funded a project for an analysis of institutional strategies in the implementation of prevention measures concerning the COVID-19 pandemic in prisons. Surveys were conducted in closed and open institutions of the judicial system across Switzerland, as well as in external residential and work settings, to document successful strategies and identify certain problems.
ABSTRACT
Background: COVID-19 is thought to induce a pro-thrombotic state, which might increase stroke risk. The purpose of this project is to assess stroke severity, type and coagulation markers such as D-dimer, fibrinogen, and CRP in patients with acute ischemic stroke (AIS) and COVID-19, compared to a control group of AIS without COVID-19. Methods: We captured discharge diagnosis of all patients at our medical center with AIS and COVID based on their discharge ICD-10 coding between June 2020 and May 2021;and identified AIS without COVID matched for age, sex, race, and ethnicity. Group 1 was AIS with COVID-19, Group 2 matched (3:1) AIS without COVID-19. We compared baseline demographics, NIHSS, Ddimer, fibrinogen, CRP, presence of large vessel occlusion (LVO) in COVID-19 AIS vs non-COVID19 AIS. We used a T test to compare parametric and Mann Whitney U for non-parametric values. Results: In total 23 (of 397 total AIS) patients were in Group 1;69 in Group 2. D-dimer levels (mean) were 3237.3 in Group 1, and 2706.8 in Group 2 (NS), Fibrinogen 464.4 and 379.8 (NS), CRP 7.9 and 9.4 (NS). Median NIHSS was 21 versus 5 (p=0.003). LVO was present in 17 patients in Group 1 (73%) and 23 (33%) in Group 2 (NS). In total, only 5.8% (23 of 397) of all AIS in our data had Covid-19 infection. Conclusion: COVID in stroke was an infrequent finding in our sample (5.8%). Patients with COVID and stroke had higher initial stroke severity, but did not differ in coagulation values. Weather coagulation markers can help distinguish patients with COVID related stroke will require subsequent studies. We need additional data before treatment recommendations specific to stroke in COVID can be made.
ABSTRACT
Objective: To evaluate stroke code time metrics and frequency of rt-PA administration in emergency department (ED) stroke codes evaluated at bedside versus telemedicine. Background: Telemedicine allows for increased access to acute stroke care. Data must be examined regarding differences in stroke code time metrics and acute thrombolytic use in Hub bedside compared to Spoke telemedicine evaluations to optimize care. Design/Methods: We retrospectively reviewed prospectively collected data from an IRBapproved registry. The sample included consecutive stroke code activations at an academic, Comprehensive Stroke Center evaluated at bedside (BG) compared to aggregate telemedicine sites (TG) from 10/1/2013-6/30/2020. We included all rt-PA treated patients. Providers were the same in both groups. We assessed 1) time from ED arrival to treatment decision, 2) ED arrival to rt-PA administration, and 3) treatment rates between groups. Groups were compared via chi-squared, logistic regression, t-test, and Pairwise Wilcoxon where appropriate. Analyses were unadjusted and adjusted for NIHSS as appropriate. Results: In total, 876 patients received rt-PA. There was no significant difference in patients receiving IV rt-PA only versus IV rt-PA and endovascular therapy between BG and TG (p=0.45). There was no significant difference in time from ED arrival to treatment decision between groups ((xBG 35.0 min vs TG 35.0 min;χBG: 35.3 min vs TG: 37.7 min;p=0.09). There was no significant difference in time from ED arrival to rt-PA administration between groups (xBG 53.0 min vs TG 55.0 min;χBG: 57.2 min vs TG: 58.3 min;p=0.69). There was no difference in rt-PA treatment rates amongst the telemedicine spoke sites (p=0.45). Conclusions: There were no significant differences in stroke code time metrics or rt-PA treatment rates in beside versus telemedicine stroke assessments in this study. Ensuring parity in stroke code evaluation is critical as telemedicine use increases due to the COVID-19 pandemic and its implication on the future of healthcare.
ABSTRACT
Owning a pet has often been associated with improved mental health among owners, including enhanced quality of life, and decreased levels of depression and loneliness. The aim of this study was to identify whether owning a cat and/or dog was associated with better psychological wellbeing during a strict lockdown period in Victoria, Australia, during the COVID-19 pandemic. Data were analysed from a large-scale mental health study: the COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE). The impact of pet ownership on levels of resilience, loneliness and quality of life were examined in a sample of 138 pet owners and 125 non-pet owners. Hierarchical linear regression analyses indicated that pet ownership was significantly associated with poorer quality of life, but not significantly associated with resilience or loneliness, after accounting for situational factors (e.g. job loss) and mood states. Contrary to expectations, the findings suggest that during a specific situation such as a pandemic, pets may contribute to increased burden among owners and contribute to poorer quality of life.
Subject(s)
COVID-19 , Cat Diseases , Dog Diseases , Animals , COVID-19/veterinary , Cats , Communicable Disease Control , Dogs , Mental Health , Ownership , Pandemics , Pets , Quality of Life , SARS-CoV-2 , Victoria/epidemiologyABSTRACT
Introduction: The COVID-19 pandemic forced immediate changes to stroke code protocols to maintain safety of patients and providers. We hypothesize that stroke code time metrics were significantly longer in the peri-COVID stroke code activations compared to pre-COVID activations. Methods: We analyzed data from an IRB-approved, prospectively collected stroke registry at a large academic, comprehensive stroke center (CSC). We included all patients that presented as stroke code activations from June 2009-August 2020, excluding spoke telestroke and in-house codes. Pre-COVID was defined as June 1, 2009-March 11, 2020 and peri-COVID March 12, 2020 to August 11, 2020. The pre-pandemic stroke code protocol began June 2009. We assessed The Joint Commission stroke code time metrics between groups. Demographic variables of baseline NIHSS, sex, race/ethnicity, age, smoking, pertinent past medical history, arrival mode, and baseline glucose were assessed. A t-test was used to compare stroke code time metrics in minutes. All analyses were done unadjusted. Results: We assessed 813 pre and 328 peri-COVID stroke code activations. Baseline demographics were significant only for an increased number of Hispanics in the pre-COVID group (22.9% vs 11.1%, p<0.001). Onset to hospital arrival time was significantly longer in the peri-COVID compared to pre-COVID group (244 vs 110 min, p<0.001). Onset to stroke code activation was significantly longer in the peri-COVID compared to pre-COVID group (243.8 vs 116.8 min, p<0.009). Time from arrival to treatment decision was significantly decreased in the peri-COVID group (29.9 vs 39.6 min, p=0.04). Time from arrival to CT scan completed (p=0.37), arrival to treatment administration (p=0.06), and onset to treatment administration (p=0.48) were not significantly different between groups. Conclusion: The COVID-19 pandemic significantly impacted the volume and demographic of stroke patients seeking emergency care. This data supports the trend of patients delaying emergent stroke care. This academic, CSC developed and implemented a COVID-19 stroke code protocol within days of a statewide lockdown. The use of telestroke in this peri-pandemic protocol may have accounted for the significant decrease in time to treatment decision.
ABSTRACT
The World Health Organization has recorded over 8 Million cases of COVID19 as of October 2020. Despite receiving appropriate lung protective ventilation and medical treatment, some of these patients develop refractory hypoxemia and acute respiratory distress syndrome. Extracorporeal membrane oxygenation has been recognized as a lifesaving therapy for patients with ARDS secondary to COVID19. There are few centers in the United States equipped with the necessary staff and the experience to take care of such critically ill patients. Some patients are too ill to be transferred with conventional mechanical ventilation, and they require interhospital transport while on ECMO. We have developed a highly specialized ECMO Deployment Team dedicated to the cannulation and transport of COVID19 patients while on venous-venous (VV) ECMO or venous-arterial (VA) ECMO. We use routine bedside ECMO cannulation via bilateral femoral vessels configuration at the outside hospital. The patient is stabilized and transported by air or ground to one of our affiliated hospitals.Here we present a series of five patients who were cannulated by our team at an outside institution and transported while on ECMO support to one of our three system hospitals. Patient ages ranged between 49-64 years old. Four patients required VV ECMO for severe hypoxemia secondary to COVID19 ARDS. One patient required VA ECMO due to viral myocarditis secondary to COVID19. Time on ECMO ranged from 9-33 days. Three of the five patients recovered successfully and were discharged home, rehab or LTAC. One patient is still currently on ECMO and one patient is deceased. There were no reported or documented transmission of COVID19 to the members of the ECMO deployment team. The potential for survival of the critically ill due to COVID19 often demands a higher level of care. However, stable transport to an appropriate institution presents a limiting factor. Our method of a dedicated ECMO Deployment Team appears to provide favorable outcome for these patients. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Introduction Coronavirus disease-2019 (COVID) in patients with advanced heart failure presents unprecedented challenges in management of cardiogenic shock. Recommendations for perioperative triaging of cardiac surgery have been proposed but none regarding LVAD implantation. To our knowledge, we are the first to report on LVAD implantation in a patient with COVID and cardiogenic shock Case Report A 37-year-old-male with Stage D, NYHA class IV heart failure on chronic milrinone was admitted for cardiogenic shock. Despite uptitration of milrinone and addition of dobutamine,the patient remained in cardiogenic shock . Our Selection Committee discussed and approved him for an LVAD. Institutional protocol required COVID screening prior to surgery and returned positive. Given the absence of clinical signs of COVID infection contrasted with the severity of shock, the decision was made to proceed with implantation. Temporary mechanical support was considered but not thought to mitigate risks of thrombosis rather adding procedural risk with ECMO cannulation and left ventricular unloading. He successfully underwent LVAD implantation as INTERMACS 1. He required high doses of heparin to achieve ACT for cardiopulmonary bypass. On day 2, he developed left-sided weakness with imaging revealing multifocal acute cerebral infarcts. Despite normal LVAD function, the embolic infarcts to multiple organs led to further deterioration and death Summary LVAD implantation in COVID patients appears inevitable. Centers must risk stratify this cohort to reduce susceptibility to thrombosis and improve outcomes. We propose an algorithm that triages patients for elective and urgent LVAD implantation based on specific coagulation and inflammatory markers (figure 1) and have successfully implanted an LVAD in a COVID patient using this. We acknowledge this method has not been validated in a large cohort and are unable to recommend anticoagulation protocols. Further research is necessary to address safety of LVAD implantation in COVID patients
ABSTRACT
Background: Thrombocytopenia (<150 x109/L) is often encountered during mechanical circulatory support. Coagulopathy in SARS-COV-2 illness (COVID-19) is increasingly recognized as a risk factor for more severe illness and higher mortality. Thrombocytopenia in COVID-19 patients requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) is challenging, and therefore identification of contributing factors may aid in management of these complex patients. Methods: A retrospective review was performed for consecutive adult patients on VV ECMO for COVID-19 respiratory failure at a single institution from March to July 2020. Patient data was obtained from our internal registry with IRB approval. Group comparisons of means were made using unadjusted t-tests and proportions were evaluated with a simple chi-square test. Results: The majority (85%) of COVID-19 patients on VV ECMO developed thrombocytopenia. Twelve of 27 patients (44%) exhibited larger drops in platelet counts following ECMO initiation (73% vs 52% fall to nadir) raising concern for heparin-induced thrombocytopenia (HIT). Nine of the 12 (75%) patients tested positive for anti-PF4 antibodies;however, none tested positive via serotonin release assay. Characteristics that affected the degree of platelet decline included the need for simultaneous continuous renal replacement therapy (CRRT) and treatment with an immunomodulating agent, convalescent plasma, or azithromycin. Discussion: Thrombocytopenia in COVID-19 patients on VV ECMO is likely multifactorial, but a more severe thrombocytopenia exists in a subset of patients. CRRT therapy and certain COVID-directed pharmacotherapy agents appear to be influential factors. Anti-PF4 antibody testing may be falsely positive and should be interpreted cautiously.
ABSTRACT
Introduction: Due to the anticipated poor outcome, risk of health care worker exposure, and potential limited resource capacity during a pandemic, extracorporeal cardiopulmonary resuscitation (ECPR) in the COVID-19 population has been discouraged. Exception to this recommendation is when an arrest occurs in a patient already being evaluated or treated with extracorporeal membrane oxygenation (ECMO). To date, experience in this subset of patients has been limited. Methods: A retrospective review was performed for all patients supported with ECMO during the COVID-19 pandemic from March 2020 to August 2020 at a single institution including patient demographics, cannulation strategies, outcomes, and complications. Results: During the study period, 32 patients were supported with ECMO. Twenty-nine patients were supported with venovenous (VV) ECMO alone;3 patients suffered cardiac arrest secondary to an acute episode of hypoxemia requiring ECPR: 1 upon presentation and 2 while already supported on VV ECMO. All 3 patients were subsequently transitioned from venoarterial (VA) to veno-arterio-venous (VAV) ECMO to VV ECMO;1 has been weaned off ECMO and discharged alive, 1 has been weaned off ECMO and remains in the ICU on mechanical ventilation, and 1 remains on VV ECMO. None of the patients suffered any complications related to the cannulation procedure. None of the patients suffered any neurological complications and have a Cerebral Performance Category scale (CPC) of 1. Conclusions: ECPR is safe and feasible in COVID-19 patients being evaluated or treated with ECMO. Centers with significant ECPR experience should consider this option in COVID-19 patients.
ABSTRACT
Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) has shown to be beneficial for the treatment of severe COVID-19. Barriers to mobilization include acuity, devices, personal protective equipment, negative pressure rooms, and healthcare worker safety. We report our experience with progressive mobility in this complex patient population. Methods: A retrospective review of adult patients requiring VV ECMO for COVID-19 was performed at a single institution from April to July 2020. A multidisciplinary team collaborated daily to determine readiness for progressive mobility. Therapy interventions followed a five-stage protocol and were evaluated using three standardized functional mobility tools (Table 1). Scores were recorded at baseline, highest during ECMO run, and at discharge. Results: Seventeen of 28 COVID-19 patients received protocolized progressive mobility during their extracorporeal support period. The mean scores of the three mobility tools demonstrated an improvement over the course of hospitalization (Table 1). At the time of data analysis, one patient had expired and four patients were still on ECMO support. Twelve (71%) were weaned from ECMO and all were alive at discharge. Of the 12 discharged patients, 6 (50%) were discharged home or inpatient rehab, 4 (33%) to long-term acute care facility and 2 (17%) to their referring hospitals. There were no adverse events or circuit complications. No health care worker infection occurred. Discussion: Early and progressive mobility with a multidisciplinary team is safe and feasible in patients with COVID-19 supported by VV ECMO and may contribute to a high rate of weaning from extracorporeal support and survival to discharge.
ABSTRACT
Introduction: Cardiac re-transplantation represents a small but growing proportion of total transplants being performed. Medical, ethical, moral and social dynamics continue to remain individualized and highly debated but more evolved with advancement in medicine for patients needing cardiac re-transplantation. We describe a case of a successful outcome in a patient requiring her third orthotopic heart transplant. Case: A 26 year old female with history of orthotopic heart transplant at age 11 for hypertrophic cardiomyopathy and subsequent re-transplantation for cardiac allograft vasculopathy (CAV) ten years later presented to our emergency room with cardiac arrest. Prior to the index hospitalization, the patient had an echocardiogram with a mildly reduced ejection fraction and an angiogram with chronic total occlusions of the right coronary artery and left circumflex artery with excellent collaterals and preserved cardiac output. Nuclear stress test showed no evidence of ischemia. Cardiac allograft vasculopathy prophylaxis with aspirin and pravastatin in addition to a triple regimen of immunosuppression of tacrolimus, sirolimus and mycophenolate mofetil were verified. The hospitalization was complicated by rapidly deteriorating biventricular function and three more episodes of cardiac arrest ultimately requiring extracorporeal membrane oxygenation (ECMO). Fortunately, the patient had negative HLAs with 0% CPRA and preserved end organ function. The selection committee thoughtfully considered her history of intermittent social marijuana use, active COVID 19 precautions in the hospital and a third sternotomy at such a young age, with likely need of possible 4th heart transplant in the future, but ultimately approved the patient for listing. Despite being Status 1, the patient had near daily loss of pulsatility for greater than 10-15 minutes which made us consider the possibility of total artificial heart. Fortunately, the patient received a local heart due to the COVID travel restrictions with total ischemic time of 98 minutes. She was induced with basiliximab and had negative retrospective and prospective crossmatches. There were no intra-op complications and post-op the patient had mild RV dysfunction requiring 4 days of inotropes. Patient was successfully discharged 9 days following her third OHT. Conclusion: Patients undergoing re-transplantation have overall poorer outcomes than those undergoing primary transplantation. Several factors influence these outcomes including timing from prior transplant, previous sternotomy, sensitization status, and renal dysfunction. With advances in medicine and pediatric patients living well into adulthood, there will be more patients requiring re-transplantation. As these trends emerge, individualized patient selection remains the key factor to improved outcomes. Our case presents an otherwise healthy young woman with graft failure without evidence of sensitization who underwent a successful third transplantation.